Department of Cardiovascular and Thoracic Surgery, IREC, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.
Department of Anesthesiology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.
Thorac Cardiovasc Surg. 2021 Sep;69(6):557-563. doi: 10.1055/s-0040-1715598. Epub 2020 Oct 12.
Postoperative pulmonary recovery after lobectomy has showed early benefits for the video-assisted thoracoscopic surgery and sparing open techniques over nonsparing techniques. Robotic-assisted procedures offer benefits in term of clinical outcomes, but their advantages on pulmonary recovery and quality of life have not yet been distinctly prospectively studied.
Eighty-six patients undergoing lobectomy over a period of 29 months were prospectively studied for their pulmonary function recovery and pain score level during the in-hospital stay and at 1, 2, and 6 months. Quality of life was evaluated at 2 and 6 months. Forty-five patients were operated by posterolateral limited thoracotomy and 41 patients by robotic approach. The postoperative analgesia protocol differed for the two groups, being lighter for the robotic group.
The pulmonary tests were not significantly different during the in-hospital stay. At 1 month, the forced expiratory volume in 1 second, forced vital capacity, vital capacity, and maximal expiratory pressure were significantly better for the robotic group ( = 0.05, 0.04, 0.05, and 0.02, respectively). There was no significant difference left at 2 and 6 months. Pain intensity was equivalent during the in-hospital stay but was significantly lower for the robotic group at 1 month ( = 0.02). At 2 and 6 months, pain and quality of life were comparable.
Robotic technique can offer similar pulmonary and pain recovery during the in-hospital stay with a lighter analgesia protocol. It clearly favors the early term recovery compared with the open limited technique. The objective and subjective functional recovery becomes equivalent at 2 and 6 months.
与非保留技术相比，肺叶切除术后的胸腔镜辅助手术和保留技术在早期都显示出对术后肺部恢复有益。机器人辅助手术在临床结果方面具有优势，但它们在肺部恢复和生活质量方面的优势尚未得到明确的前瞻性研究。
在 29 个月的时间内，前瞻性研究了 86 例行肺叶切除术的患者，以评估他们在住院期间和 1、2、6 个月期间的肺功能恢复和疼痛评分水平。在 2 个月和 6 个月时评估生活质量。45 例患者行后外侧有限开胸术，41 例患者行机器人手术。两组患者的术后镇痛方案不同，机器人组较轻。
住院期间肺功能检查无显著差异。1 个月时，机器人组的 1 秒用力呼气量、用力肺活量、肺活量和最大呼气压力明显更好（ = 0.05、0.04、0.05 和 0.02）。2 个月和 6 个月时无显著差异。住院期间疼痛强度相当，但机器人组在 1 个月时明显较低（ = 0.02）。2 个月和 6 个月时，疼痛和生活质量相当。
机器人技术可以在住院期间提供类似的肺部和疼痛恢复，同时采用较轻的镇痛方案。与开放有限技术相比，它明显有利于早期恢复。2 个月和 6 个月时，客观和主观功能恢复相当。
